Iatocracy

(13 Dec 09)

            New word I learnt, not easily googled (strange how this word that I’d never heard of a few years ago has become an integral activity of my daily life). It means doctors who run hospitals. It comes from the Greek iato (physician) and kratein (rule). It’s so common in Goa that you can’t think there can be any other ‘runners’ of hospitals. Dr X’s clinic or nursing home means Dr X owns it, runs it, right? It’s taken for granted, no other kind of hospital is or was known. But things they are a-changing: even doctors who ‘own’ hospitals, large ones of 250 plus beds, don’t run them nor own them entirely. There are non-medic partners, financers, Chief Executives. The administration, the housekeeping, the human resources management, food, pharmacy… professionals are employed to manage those departments. There are managers in the operation theatres and there is a ‘marketing’ department to let the aam junta know what services are provided, how to avail of those services, their costs, etc. The managers of these functions aren’t doctors. Think of Vrindavan, Apollo, Manipal, and you’ll get the idea.

            Nursing homes are slowly being edged out by big hospitals, or being taken over or franchised by chains. Something like the corner grocer shop will eventually become a stall in a mall…. Not exactly, but something like that. You say it can’t happen in Goa? Have another think. It’ll happen sooner rather than later.

            The result of this, what with accreditation, etc, is going to be transparency. And higher costs. Patients will start insisting upon knowing what is being done to them and why. “I’m a doctor, I know better, and because I say so” is not an answer patients will accept. Will it lead to dilution of trust? Questions will not be feared by doctors who are confident about what they’re doing, and who are concerned about patient care more than their own reputations. We do have many of those in Goa. Patients will start questioning their bills, indeed, will start asking for receipts for consultations: ouch, that will hurt many private practitioners in Goa for sure. Patients will start insisting on qualified nurses rather than village girls dressed up in white uniforms. Medical records will be meticulously maintained and those will ensure that clinical standards are high. If one wants a medical certificate, it’ll be difficult to ‘buy’ one, one would have to apply to a records’ department for it and it’ll therefore have to be genuine. Life will get difficult for many, but the honest and straight will benefit.

            The other thing that will be affected is: commission or cut practice, which I thought was a purely big-city thing until one Goan doctor told me otherwise. The entry of the hospital administrator would, in theory, eliminate many wrong doings in the world of hospitals. But we’re Indians, and am sure we’ll find a way to overcome that. However, the fact is, the demise of iatocracy will eventually lead to evidence based clinical practice. Words like ‘good’, ‘nice’, will not suffice. The qualities of a doctor would have to be quantified. For example, one would have to explain just what a successful surgery is: number days spent in hospital, infection rates, etc. These would be measured and available to the public. Does it mean mistakes won’t happen? Not at all, it means the attempt will be strong to eliminate mistakes. Like in the aviation industry. Errors aren’t pardoned. They’re never forgiven. And therefore, the entire system is geared to make none. What it does mean is that mistakes aren’t swept under the carpet or restricted to medical ears: expiry audits will be held and used to better methods and add to scientific knowledge. The person won’t be important, the action will be.

            Today, there are more non-medical managers than doctors, but again, this is bound to change as more and more doctors themselves are opting to become managers. Clinicians becoming managers, physicians heading hospitals will happen again once they actually study management techniques and master systems and finance. It’s a circle that will get completed. The iatocrats will rule once more.

@@@@@